Feasibility of pharmacy-initiated pharmacogenetic screening for CYP2D6 and CYP2C19

Swen, Jesse J.; Straaten, Tahar van der; Wessels, Judith A.M.; Bouvy, Marcel L.; Vlassak, E. E. W.; Assendelft, W.J.J.; Guchelaar, Henk‐Jan

doi:10.1007/s00228-011-1130-4

Cited by 31 publications

(25 citation statements)

References 24 publications

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“…The time seemed to be well spent, given that the majority of patients (54%) consented to PGx testing and agreed to participate in the study once they learned more about PGx. As demonstrated by other studies, 31,32 this finding suggests that patients empowered with knowledge about PGx are receptive to undergo PGx testing, which could improve their medication management. Further, this indicates that either prescribers need to have sufficient time to educate patients on PGx before testing, or will need to implement a consult-based service, such as ours, and allow a pharmacist to provide this education.…”

Section: Discussionsupporting

confidence: 61%

“…This target sample size was estimated as sufficient to assess feasibility, as previous pharmacist-physician collaborative studies and pharmacist-led PGx studies have demonstrated implementation feasibility with similar sample sizes. 23,[27][28][29][30][31][32] In March 2016, the research pharmacist began reviewing charts of the practice sites' electronic health records to determine potentially eligible patients, and in April 2016, enrollment commenced. When the research pharmacist was on site, she collaborated with staff to introduce the consent process to potentially eligible patients and to ascertain whether these patients were experiencing any MRPs around the time of the scheduled PCP appointment.…”

Section: Patient Enrollmentmentioning

confidence: 99%

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Implementation of a Standardized Medication Therapy Management Plus Approach within Primary Care

et al. 2017

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Purpose: The purpose of this study was to implement a clinical pharmacist-led medication therapy management (MTM) service within a primary-care setting that is enhanced by 1) a clinical decision support system (CDSS) that includes a unique combination of medication risk mitigation factors, which aids the pharmacist in interpreting the medication profile, and 2) pharmacogenomics (PGx) testing.Methods: This was a service implementation study, whereby Medicare beneficiaries were eligible if they were patients of Elmwood Family Physicians, a private family, primary care practice with 2 locations in New Jersey, and were on at least 7 medications. Patients had a medication reconciliation completed by a pharmacist and performed a PGx buccal swab. Patient information was run through a CDSS to aid the pharmacist with screening for multidrug interactions and assessing patient's medication-related risks. The output of the CDSS was used to create recommendations and provide a consult to the physicians. Recommendations were followed up by return of the consult. Primary care physicians (PCPs) are the most frequent prescribers of medications, with over 65% to 75% of medications being prescribed in the primarycare setting. 1,2 Although medications are a critical intervention for the prevention and treatment of medical conditions, they also can be associated with medication-related problems (MRPs). A MRP is This article was externally peer reviewed.

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Section: Discussionsupporting

confidence: 61%

Section: Patient Enrollmentmentioning

confidence: 99%

Implementation of a Standardized Medication Therapy Management Plus Approach within Primary Care

et al. 2017

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“…22 We have shown that it is possible for both family physicians and pharmacists to obtain saliva samples from patients, send the samples to the laboratory, complete the biophysical and laboratory data needed for an MDSS and make decisions based on individualized medication options. In a pharmacybased study (n = 54) by Swen and colleagues, 23 9 saliva samples (16.7%) contained too little DNA, whereas we had 1 sample (0.5%) that contained too little DNA. We achieved an overall call rate of 99%, compared with Swen and colleagues' call rates of 93.3% and 100% for CYP2D6 and CYP2C19, respectively.…”

Section: Discussionmentioning

confidence: 89%

Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study

et al. 2016

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Background: Inappropriate prescribing increases patient illness and death owing to adverse drug events. The inclusion of genetic information into primary care medication practices is one solution. Our aim was to assess the ability to obtain and genotype saliva samples and to determine the levels of use of a decision support tool that creates medication options adjusted for patient characteristics, drug-drug interactions and pharmacogenetics. Methods:We conducted a cohort study in 6 primary care settings (5 family practices and 1 pharmacy), enrolling 191 adults with at least 1 of 10 common diseases. Saliva samples were obtained in the physician's office or pharmacy and sent to our laboratory, where DNA was extracted and genotyped and reports were generated. The reports were sent directly to the family physician/pharmacist and linked to an evidence-based prescribing decision support system. The primary outcome was ability to obtain and genotype samples. The secondary outcomes were yield and purity of DNA samples, ability to link results to decision support software and use of the decision support software. Results:Genotyping resulted in linking of 189 patients (99%) with pharmacogenetic reports to the decision support program. A total of 96.8% of samples had at least 1 actionable genotype for medications included in the decision support system. The medication support system was used by the physicians and pharmacists 236 times over 3 months.Interpretation: Physicians and pharmacists can collect saliva samples of sufficient quantity and quality for DNA extraction, purification and genotyping. A clinical decision support system with integrated data from pharmacogenetic tests may enable personalized prescribing within primary care. Trial registration: ClinicalTrials.gov, NCT02383290. AbstractResearch Research CMAJ OPENCMAJ OPEN, 4(3) E529fective at changing prescribing decisions, 13 whereas information given within a physician's workflow has been found to be effective in reducing inappropriate orders for imaging. 14 A medication decision support system (MDSS) is a health information technology system that is designed to provide health care professionals with clinical decision support with medication decision-making tasks. These systems assess whether a drug is safe and effective for the patient, taking into account other medications, diseases and the patient's physical state. 15 We have developed a patient-centred MDSS that assesses the potential drug-drug, drug-condition, druggene and drug-drug-gene interactions and produces a list of drug options least likely to cause harm and most likely to be effective.We conducted a study to assess the DNA collection processes, investigate a panel of pharmacogenetic tests relevant to primary care patients and assess the use of an MDSS. The value of the MDSS will be assessed once feasibility of all processes has been shown. MethodsOver an 18-month period before the start of the trial, we developed a pharmacogenetic panel, a pharmacogenetic report and an MDSS for use in primary...

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“…They found that approximately 60% of patients consented to the testing; a high percentage considering the screening was not directly related to their clinical treatment. Their study provided evidence for pharmacy-initiated pharmacogenetic screening to be feasible in a primary care setting (148). A retrospective pilot study by Mü ller et al examined 35 patients with schizophrenia genotyped for CYP2D6 and CYP2C19 metabolizer status using the Amplichip † test.…”

Section: Pharmacodynamicsmentioning

confidence: 99%

Genetics of antipsychotic drug outcome and implications for the clinician: into the limelight

Changasi

Shams

Pouget

et al. 2014

Translational Developmental Psychiatry

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Background and purpose: Antipsychotics (APs) are the primary method of treatment for schizophrenia and other psychotic disorders. Unfortunately, lengthy trial-and-error approaches are typically required to find the optimal medication and dosage due to a large interindividual variability with outcome to AP treatment. The literature has shown abundant evidence for a genetic component in individuals' responses to APs. Pharmacogenetic studies analyze specific genetic markers and their association with symptom improvement and occurrence of side effects with APs. This research aims to optimize AP drug treatment by usage of predictive testing and to personalize medicine. Recent findings: This review will highlight the most consistent findings in pharmacogenetics of APs and will update the reader on the clinical implications. This will include how genetic variants modulate AP drug levels, side effects, and therapeutic symptom improvement (i.e. response) to AP treatment. Summary: Several promising findings were obtained implicating gene variants of the dopamine receptor genes in addition to gene variants of serotonin receptors for response and common side effects. Notably, effect sizes appear to be particularly high in the genetics of side effects compared to response. One example is antipsychotic-induced weight gain where the leptin, HTR2C and in particular the melanocortin-4-receptor (MC4R) genes have been implicated in weight gain in children and adolescents. Consistent findings were also obtained for genes implicated in tardive dyskinesia and agranulocytosis. However, the most clinically relevant findings pertain to genes involved in drug metabolism such as the CYP2D6 and CYP2C19 genes which have been included in the first genetic test kits such as the Amplichip †

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Feasibility of pharmacy-initiated pharmacogenetic screening for CYP2D6 and CYP2C19

Cited by 31 publications

References 24 publications

Implementation of a Standardized Medication Therapy Management Plus Approach within Primary Care

Implementation of a Standardized Medication Therapy Management Plus Approach within Primary Care

Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study

Genetics of antipsychotic drug outcome and implications for the clinician: into the limelight

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